obsolete calculus of bile duct with acute cholecystitis

Obsolete Calculus of Bile Duct with Acute Cholecystitis

The term "obsolete calculus of bile duct with acute cholecystitis" refers to a condition where there is an obstruction in the common bile duct caused by a gallstone, leading to inflammation of the gallbladder (acute cholecystitis). This condition was previously recognized as a distinct entity, but it has largely been superseded by more modern classifications and understanding of the disease.

Historical Context

In the past, the presence of a gallstone in the common bile duct was considered a key factor in the development of acute cholecystitis. However, with advances in medical knowledge and diagnostic techniques, it is now understood that the condition is often associated with other factors, such as inflammation of the gallbladder wall, thickening of the gallbladder wall, and peri-cholecystic fat density.

Current Understanding

The current understanding of acute cholecystitis emphasizes the importance of inflammation of the gallbladder wall, rather than just the presence of a gallstone. The condition is now classified into different grades based on its severity, with Grade III being the most severe form, which can involve dysfunction of multiple organ systems.

Relevance to Modern Practice

While the term "obsolete calculus of bile duct with acute cholecystitis" may still be encountered in older medical literature, it is no longer a commonly used or relevant term in modern clinical practice. The focus has shifted towards more accurate and comprehensive classifications of the disease, such as Tokyo grades I-III, which take into account the severity of inflammation and potential complications.

References

• [3] Gallstones are common and present as acute calculus cholecystitis (ACC) in 20 % of patients with symptomatic disease, with wide variation in ...
• [7] Gallstones are common and present as acute calculus cholecystitis (ACC) in 20 % of patients with symptomatic disease, with wide variation in ...
• [8] An impacted stone in the cystic duct or neck of the gallbladder is diagnostic of acute cholecystitis; however, this is a rare finding with ultrasonography. Most ...

Common symptoms of acute cholecystitis include:

• Upper abdominal pain, especially in the upper right, which may also spread to your right shoulder blade or back [12]
• Gallbladder pain builds quickly to a peak, which may be severe and feel sharp, dull, or crampy, and may worsen when you breathe deeply [12]
• Nausea and vomiting are common symptoms, especially in older patients, where the symptoms may be nonspecific (e.g., anorexia, malaise, weakness) [13]

Other signs and symptoms:

• Fever may be present, although it can be absent in some cases, especially in older patients [13]
• Localized perforation or another complication develops in 10% of patients who experience acute cholecystitis [13]
• Pain in the mid-back or shoulder may also occur, which could be present for years until correctly diagnosed [4]

Important note:

• Most (≥95%) patients with acute cholecystitis have cholelithiasis, meaning they have gallstones [13]

Based on the provided context, it appears that you are looking for diagnostic tests used to diagnose obsolete calculus of bile duct with acute cholecystitis.

According to search result [8], Ultrasonography is now the primary imaging technique for the assessment of the gall bladder and bile ducts, and oral cholecystography is obsolete. However, this does not directly answer your question.

Search result [10] mentions that Tests and procedures used to diagnose cholecystitis include: Blood tests, Imaging tests that show your gallbladder, such as abdominal ultrasound, endoscopic ultrasound, CT scan or magnetic resonance cholangiopancreatography can make pictures of your gallbladder and bile ducts. However, it does not specifically mention obsolete calculus of bile duct with acute cholecystitis.

Search result [4] mentions that Magnetic resonance cholangiopancreatography (MRCP) is useful for evaluating concurrent choledocholithiasis or alterations of the biliary tract. This could be relevant to your question as MRCP can evaluate the bile ducts, but it does not specifically mention obsolete calculus.

Search result [7] mentions that Hepatobiliary iminodiacetic acid (HIDA) scan is useful in diagnosing acute cholecystitis secondary to cystic duct obstruction. However, this does not directly answer your question either.

Based on the provided context, it seems that there are limited diagnostic tests specifically for obsolete calculus of bile duct with acute cholecystitis. However, some imaging tests such as MRCP and HIDA scan may be useful in evaluating the bile ducts and gallbladder.

Here is a summary of the relevant information:

• Ultrasonography is now the primary imaging technique for the assessment of the gall bladder and bile ducts (Search result [8])
• Imaging tests that show your gallbladder, such as abdominal ultrasound, endoscopic ultrasound, CT scan or magnetic resonance cholangiopancreatography can make pictures of your gallbladder and bile ducts (Search result [10])
• Magnetic resonance cholangiopancreatography (MRCP) is useful for evaluating concurrent choledocholithiasis or alterations of the biliary tract (Search result [4])
• Hepatobiliary iminodiacetic acid (HIDA) scan is useful in diagnosing acute cholecystitis secondary to cystic duct obstruction (Search result [7])

Please note that these tests may not specifically diagnose obsolete calculus of bile duct with acute cholecystitis, but they can be used to evaluate the gallbladder and bile ducts.

Treatment Options for Obsolete Calculus of Bile Duct with Acute Cholecystitis

Acute cholecystitis, often associated with gallstones, can lead to serious complications if not promptly treated. In cases where the calculus (gallstone) has moved into the common bile duct, causing obstruction and inflammation, treatment options are crucial.

• Antimicrobial Therapy: Initially, patients should receive antimicrobial therapy to address potential infection. However, this may need to be discontinued once cholecystectomy is performed, unless there's evidence of ongoing infection ([1][7]).
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs like diclofenac or indomethacin are recommended for their analgesic effects. They can help relieve pain from gallbladder distention ([3][8]).
• Surgical Intervention: The treatment of choice for acute cholecystitis, especially in cases with complications, is surgical cholecystectomy. This involves removing the gallbladder to prevent further inflammation and potential sepsis ([4][5]).

Key Considerations

When treating obsolete calculus of bile duct with acute cholecystitis, it's essential to consider the following:

• Prompt Clinical Diagnosis: Early diagnosis is crucial to prevent serious complications.
• Optimal Timeframe for Surgery: The optimal timeframe to perform laparoscopic cholecystectomy (ELC) should be considered to ensure effective treatment ([2]).
• Patient Condition: Patients in critical condition may require specific treatment and close monitoring.

References

[1] by L Mencarini · 2024 · Cited by 11 — In case of local complications such as pericholecystic abscesses or gallbladder perforation, the antimicrobial therapy should be discontinued ...

[2] The optimal timeframe to perform ELC is ...

[3] Jul 13, 2022 — Anti-inflammatory medications such as ketorolac or indomethacin have been reported to be effective in relieving pain from gallbladder distention ...

[4] by B Balmadrid · 2018 · Cited by 40 — The treatment of choice would be a surgical cholecystectomy.

[5] Nov 15, 2022 — Surgical intervention is often necessary for acute cholecystitis with complications.

[7] Antimicrobial therapy may need to be discontinued once cholecystectomy is performed, unless there's evidence of ongoing infection.

[8] NSAIDs like diclofenac or indomethacin are recommended for their analgesic effects.

Based on the provided context, it appears that you are looking for a differential diagnosis of a condition where there is an obstruction in the bile duct due to an old gallstone (obstructive calculus) and inflammation of the gallbladder (acute cholecystitis).

Here are some possible conditions that may be considered as part of the differential diagnosis:

• Ascending cholangitis: This is an infection of the bile duct, which can occur when there is a blockage in the duct. It can be caused by bacteria entering the bile duct through the bloodstream or from the gallbladder.
• Acalculous cholecystitis: This is inflammation of the gallbladder without the presence of gallstones. It can be caused by various factors such as ischemia, trauma, or infection.
• Biliary colic: This is a condition where there is a blockage in the bile duct due to a gallstone, but it does not cause significant inflammation of the gallbladder.
• Choledocholithiasis: This is the presence of a gallstone in the common bile duct. It can cause obstruction and inflammation of the bile duct.

These conditions may present with similar symptoms such as abdominal pain, jaundice, and fever, making differential diagnosis challenging.

According to [10], imaging evidence of dilation of the common bile duct, along with finding a cause of obstruction (e.g., stone or stricture), can be used to diagnose acute cholecystitis. Additionally, systemic signs of inflammation such as fever and rigors are also important diagnostic criteria [10].

It's worth noting that the presence of an old gallstone in the bile duct may suggest a chronic condition, while acute cholecystitis is typically associated with a sudden onset of symptoms.

References:

[10] Tokyo Guidelines 2018: Definite diagnosis requires at least one item in each of three categories (based on Tokyo Guidelines 2018): (1) Systemic signs of inflammation Fever; Rigors [number 10]

[5] Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg. 2005;92:1241–1247. doi: 10.1002/bjs.4955. [Google Scholar] 13